We must always be sufficiently present to avoid harming our patients or ourselves, whatever our preoccupying circumstances. Life-threatening illness complicates this responsibility. But does personal vulnerability mean professional suicide? Betty Hellman notes that she never disclosed her cancer while undergoing treatment, fearing the impact on her practice.
Containment is essential in our work. It guards against impingement and deepens the therapy. The myth of the intact healer, however, fosters not appropriate containment but a closeting of self that can lead to disturbing denial. Analysts Andrew and Amy Morrison dealt openly with the latter's terminal cancer because of the damage they'd observed when colleagues kept their own serious illnesses secret.
Of course, many patients come to therapy with histories of traumatic intrusion; we rightfully reveal little so as not to re-injure them. Yet equally harmful is the taboo against discussing--or even acknowledging--reality. Patients long accustomed to being told their perceptions are wrong or unwelcome learn to keep quiet. Left alone in shame to wonder and distort, they also learn to stifle feelings and curiosity while blaming and distrusting themselves. Too little therapist disclosure can also recapitulate destructive dynamics.
Mindful of these complexities in revealing my cancer, I tried to strike a balance between opacity and transparency, answering most questions directly while also exploring feelings and associations.
My patients responded with heartfelt concern. Almost all wanted to know more but hesitated to ask out of a fear of being seen as intrusive or inappropriate. We explored their ambivalence about knowing, and whether they felt intruded upon. Unsurprisingly, my cancer evoked issues of caretaking, inhibition, mortality, abandonment, and loss. But most pronounced was a profound feeling of mutual care and attachment.
Cancer also brought greater clarity and a sense of urgency. I felt opened up in a way that made me more present, better able to bear my patients' raw affects, and more inclined to get to the heart of things.
During the eight months my cancer was an inescapable presence in the room, I am sure I missed many opportunities with my patients. But isn't this always the case? A truism of therapy is that such occasions will come around again. Banishing the myth of the intact healer instead of our vulnerability enables us to better explore the fraught and fertile opportunities that arise when life inevitably intrudes.